Why Most Of Us Are Nutrient Deficient And What To Do About It

Introduction:
Coming up on this episode of The Doctor’s Farmacy.

Chris Kresser:
If you have a severe deficiency of vitamin C, for example, you’ll get scurvy and that’s pretty obvious. You’re not going to miss that, right? But if you have a mild deficiency of vitamin C, you might find yourself getting a lot of colds and flus and other types of infections. You might find your inflammation and oxidative stress is going up.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, and that’s Farmacy with an F. A place for conversations that matter. And if you’ve ever wondered about whether you should take supplements or if they just make expensive urine, this is the podcast you want to listen to because it’s with my good friend, an extraordinary scientist, thinker, and innovator in the field of functional medicine. Dr. Chris Kresser, who’s a co-founder of California Center for Functional Medicine. The founder of the Kresser Institute. The host of the top ranked Health podcast, Revolution Health Radio, which I’ve been on multiple times. And creative chriskresser.com and the New York Times bestselling author of the Paleo Cure and Unconventional Medicine. He’s really the guy to go to for so much and I certainly go to him for a lot of my information.
He’s an educator and clinician in the field of functional medicine, ancestral health. He’s trained over 2000 clinicians and health coaches from over 50 countries. He was named one of the 100 Most Influential People In Health And Fitness by Greatest. And has appeared on Dr. Oz, Time Magazine, Atlantic, NPR, Fox & Friends and lots more. And he’s recently created a new product line and we’ll talk about that a little bit, called Adapt Naturals. Designed to add back in what the modern world has squeezed out and help people perform and feel their best. So welcome Chris.

Chris Kresser:
Mark, it’s always a pleasure to speak with you. I love our conversations and I’ve been looking forward to this one.

Dr. Mark Hyman:
Great. Okay, so I get this all the time, Dr. Hyman, listen, I eat a Whole Foods diet, I eat healthy. Why should I take supplements? I mean, our hunter gatherer ancestors never had to take supplements. Why should I take supplements and isn’t it just going to make expensive urine? And why should I waste my money? And is it really worth it? And by the way, a lot of people think it’s worth it because I think there’s a 20 plus billion dollar supplement industry out there. So some people obviously think so. But this is a question clearly that has been debated. It’s certainly something that doctors are still in question about. And just a little aside, I often would in lectures with doctors, ask doctors who recommends supplements to their patients? And very few people would sheepishly raise their hand. And I’m like, how many of you actually take supplements and 70 or 80% of the room would raise their hand.

Chris Kresser:
I mean that’s actually a great segue because I would say I was one of those people who asked whether supplements are worthwhile if I’m eating a nutrient dense whole food diet. And the honest Mark, in my heart of hearts, I wish the answer was no. I wish that we could just get all of the nutrients we need from food because that is the way that human beings are designed to get nutrients. And you and I both agree that no matter what the answer to the supplement question is, a nutrient dense whole foods diet is the core foundation for optimal health. There’s no debate on this. Everyone I know who’s thinking about this in the right way, is on the same page there. But then the real question that you asked, which I think is the million dollar question, is if you are eating that kind of diet, might you still benefit from supplements?
And I think the answer is unequivocably yes at this point because of several factors. So number one is that changes in soil quality. So I think you and I have talked about this before, you’ve written about this extensively, but we’ve seen over the last 50 years in particular changes to the microbiome of the soil. So it’s the same thing that’s happened to our gut, but in the case of soil, it’s because of chemical fertilizers and pesticides and industrial agriculture and mono-cropping has changed the composition of the soil biome so that the plants are less able to extract nutrients from that soil. And you’ve seen declines of anywhere from 20 to 40% or more across the board in vitamins and minerals. And one example I came across in a study that just really stood out to me, and I’ve always remembered is we’d have to eat eight oranges today to get the same nutrition from a single orange that our grandparents did. That’s just two generations right?

Dr. Mark Hyman:
Of course then we get diabetes, but that’s another problem.

Chris Kresser:
Yeah, exactly. Well, that’s part of what we’re talking about here. We see an increase in the sugar and sweet content of the orange, but a decrease in the nutrient value. So that’s a double whammy. You get hit on both sides. So even if you’re eating healthy food, you’re not getting the same level of nutrition that even your grandparents got, much less the paleo ancestors that you referred to as [inaudible 00:04:57]. So that’s number one.
Number two is something I also know you’re passionate about was the shift from a local organic food system to an industrial food system that’s global in nature. And why that’s important in terms of nutrient value is that as soon as you take a plant out of the ground, it starts losing nutrients immediately. And so that’s not a big deal if you’re picking carrots out of your backyard or picking a tomato off the vine, or maybe you’re going to a farmer’s market where the food was just harvested that morning or the day before. But if you’re like most people and you’re going shopping in the grocery store for your produce, chances are that carrot might have traveled 1800 miles, which is the average length that a carrot travels to get to the grocery store. Or it could have even come … I mean, in California you get basil from Guatemala. So by the time the food hits your mouth, it’s 40 to 50% depleted just because of how we are growing and distributing food now across the globe. So that’s another big issue.

Dr. Mark Hyman:
Yeah, no-

Chris Kresser:
The third one-

Dr. Mark Hyman:
Before you go, I just had a reflection on my own garden. I go to the farmer’s market, I go to a really kind of equivalent of a local Whole Foods in the Berkshires where I live and I buy the best organic broccoli and asparagus and it tastes okay, it tastes good. But when I grow the asparagus in my garden and I pick it and I eat it literally within seconds, or when I take the broccoli for my garden and pick it and eat it, it’s like an entirely different vegetable. So the truth is, most of what we’re eating is already so depleted and the flavor that’s in the plants comes from the phytochemicals and the nutrients in them. So it’s not just that they taste better, it’s that they actually are better. And I think that’s what most people don’t realize.

Chris Kresser:
You could even see it in the color too, right? Because phytonutrients are what provide the color. So you go to the grocery store and you buy a tomato, it looks pale and kind of waxy. If you were to bite into it or cut into it and taste it, it’s kind of like water, tomato flavored water or something like that. When I was growing up, that’s how tomatoes were. And then I can still remember the first time I tasted a real tomato off of a vine, it was like an explosion in my mouth of tomatoness that I had never even experienced before. So this is a huge issue. And I think it’s one of the biggest problems we face in terms of nutrient density.
Another big one is a growing toxic burden. So we have heavy metals like lead and mercury and arsenic and cadmium in the food supply now. We’re still seeing stories almost every week about lead in drinking water all over the country. We’ve got toxins like glyphosate and bisphenol A, and in addition to the effect that these toxins have on our bodies, they also bind to nutrients and they make those nutrients impossible to absorb. So that’s a big problem that keeps growing. And then there are several …
I could go on and on, but I’m going to stop with this next one. We have a growing prevalence of chronic disease. Six in 10 Americans have a chronic disease, and four in 10 have multiple chronic diseases. And you get hit on both sides with that one as well. So chronic diseases increase the demand for nutrients. When you have a chronic disease, you actually need more nutrition than someone without a chronic disease and they also decrease the absorption of nutrients or the utilization of nutrients. So let me give you an example. People with obesity or diabesity, as you’ve termed it, they are less likely to absorb vitamin D from food and they’re less efficient at producing vitamin D from a given amount of exposure to sunlight. So someone whose obese might need to take 10,000 IU per day of vitamin D just to maintain a normal level versus someone who’s lean, maybe 2000 IU would be sufficient for them. So there’s all kinds of examples like that as well.
So the truth is we’re just not living in the world that our ancestors lived in. And when I finally was able to accept that and come to terms with it, the question was, okay, do I want to hold onto this ideological stance that we should be able to get nutrients from food and suffer as a result of that and my patients suffer? Or do I want to figure out a way that we can close that gap and build on the foundation of a whole foods nutrient dense diet with smart supplementation? And that’s where I’ve ended up in my career. I know that’s where you’ve ended up in your career as well.

Dr. Mark Hyman:
For sure. For sure. Well, people say, Dr. Hyman, do I really need supplements? I always say, I don’t think anyone needs supplements, but only under certain conditions. First, they have to hunt and gather their own wild food. Second, they have to be exposed to no environmental toxins, have no chronic stress, sleep nine hours a night, go to bed with the sun, wake up with the sun, drink pure clean water. And if that describes you, then no, you don’t need supplements. But for the rest of us, I think we do.

Chris Kresser:
Yeah. That’s a great way of putting it. Absolutely.

Dr. Mark Hyman:
And I think, you just hit up upon a couple things that are worth emphasizing. The quality of the food we’re eating is so much less than it used to be. And a lot of it has to do with the agricultural practices that degrade our soil. And it’s the symbiosis between the microbes in the soil and the nutrients in the soil that makes them free to be absorbed by the plant. So if you have dead soil, otherwise known as dirt, which is what most of food that’s grown in America because of the chemicals we put on are essentially poisons. They’re like antibiotics for the soil. They kill the microbial life of the soil. If you don’t have those microbial compounds and the microbial fungi in the soil, the plants can’t extract the minerals and the nutrients from the soil, which is why they’re so much less nutritious.
And the other thing I think that people don’t realize is that climate change and increasing temperatures and carbon in the atmosphere is creating a bigger problem because it’s causing the plants to absorb more carbon dioxide, which is a good thing. But what does that carbon dioxide turn into? Look, carbon carbohydrates, it’s the same route. So it turns into a starchier plant. So by nature the plants become less nutritious because they have more starchy carbohydrates, less protein, and less nutrients. So we’re kind of in this vicious cycle of a degrading food supply while we’re seeing increasing needs for nutrients based on our increasing toxic world, increased stresses and this sort of vicious cycle you mentioned. Plus you mentioned the medication issue, and that’s another whole issue. Doctors always say, Oh, don’t take this nutrient, it can interfere with your medication. Well, the opposite’s true. A lot of medications interfere with nutrients. And so 81% of Americans are on some type of medication and they’re often interactions. If you’re on a diuretic for blood pressure, you lose magnesium. If you’re on an acid blocker for a reflux, you can’t absorb B-12. And I could go on and on.

Chris Kresser:
Metformin and folate Metformin and B-12. Yep.

Dr. Mark Hyman:
Exactly. So that’s a whole issue. The other thing I want to touch on is this idea is, can you really get your nutrients from food? And I generally don’t think so unless you’re a complete OCD nut. And not to disparage one of my patients, but I had this one patient who’s like, Dr. Hyman, I figured out if I eat four basil nuts, 25 pumpkin seeds and four ounces of liver and she went on and on, basically covered every nutrient and where it came from and what amount was in each food and how to eat. So she was counting her nuts, literally.

Chris Kresser:
It’s a full time job.

Dr. Mark Hyman:
It was a full time job. Yeah.

Chris Kresser:
Other than her and a few of our patients, we’ve had the similar type, they bring in the Excel spreadsheet where they check off the foods that they’re eating. And that’s really what it does take often to get it right. And most people are not going to go through to that level of effort. For sure.

Dr. Mark Hyman:
Yeah. For sure. The other thing I want to have you address next is this idea of are we really nutrient deficient? So yeah, the food is maybe less nutritious, but I mean, how common are nutritional deficiencies in practice truly? And why don’t we hear more about it? And I know I’ve had the luxury and privilege of being able to test tens of thousands of patients over decades for nutritional testing. And I do it on everybody as a baseline. I check blood pressure, check cholesterol, check heart rate, check their weight, it’s checking the nutrient levels. And it’s just astounding to me the level … and by the way, my practice is generally made up of people who are health conscious. They’re not like I call them virgin patients who’ve been eating McDonald’s their whole life. And I have a few of those and it’s even more shocking. But the level of nutritional deficiency, even among an educated, well off, conscious population is still staggering. So can you just talk about the widespread nature of nutritional deficiencies, what we know about them and what they are? What the most common ones?

Chris Kresser:
Yeah, absolutely. And that’s what opened my eyes to this as well. 15 years of treating patients and every patient that walks through the door gets a full nutrient analysis. And I can probably count on one hand the number of patients that had adequate levels of all nutrients in all of those 15 years, which is really shocking for the same reason, I have highly motivated, educated patients who are way far above the norm in terms of the attention that they’re paying to this. And they were still not getting enough and it was contributing to all of their symptoms. Everything from minor symptoms like fatigue and poor quality sleep and slight mood disturbances to full on diseases, autoimmune disease and gastrointestinal issues, thyroid problems, et cetera. I know you’ve seen the same thing.
So let’s just kind of zoom out and see how do we even know how much nutrients that we need to thrive? Well, the answer is we don’t have great data on that yet because most of the scales, nutrient density scales and standards for how much we should get like the recommended dietary allowance or RDA. The RDA was designed in World War II when they were trying to figure out rations for soldiers. The question they were asking there was certainly not how can we optimize these soldiers’ health? They were asking how can we keep them alive during war time? How can we make sure they don’t develop scurvy and rickets and these diseases of malnutrition? And so that’s one problem. The standard that we’re using is really only designed to prevent serious problems. It’s not designed for optimal health. Even within that standard though, they often haven’t been updated for 25, 30 years, plus.
A great example is magnesium. So the RDA for magnesium was last updated in 1997. And RDAs are based on body weight. So if there’s been a change in body weight over a given period of time, the RDA should be updated and go up, but it hasn’t. So in 1997, the average body weight for a female was about 135 pounds. And the average weight for a male was about 166 pounds. And the RDA was 420 milligrams per day for men and 320 for women. Now today though, the average weight of a woman is 170 pounds, and the average weight of a man is 196 pounds. And when researchers recalculated the RDA for magnesium based on this, it went up to 650 for men and 530 for women. And the average intake is only about 340 grams a day in this country. So that tells us most people are getting 200 to 300 milligrams per day, less magnesium than they need. But if you were to just go on the web and search for the RDA for magnesium, it’s still 420 for men and 320 for women for 25 years ago.
So I think we’re dramatically underestimating the rates of nutrient deficiency for that reason. But even with all of these caveats, the latest nurses health data show that the majority of Americans are deficient in not just one essential nutrient, but several. So I’ll give you some stats here. A hundred percent don’t get enough potassium, 94% don’t get enough Vitamin D, 92% don’t get enough choline, 89% don’t get enough Vitamin E, 67% don’t get enough Vitamin K, 52% don’t get enough magnesium. But as I just said, that’s actually probably closer to a hundred percent. 44% calcium, 43% vitamin A, I could go on. But these statistics are shocking because they show that most people are deficient in most nutrients full stop.

Dr. Mark Hyman:
So how do we measure these? Because when you go to the doctor, they don’t go, Oh wow, we just checked your nutrient levels and they’re all deficient. In functional medicine, we have ways of testing them. But what are the most important diagnostic tests for nutrient deficiency that people should be focused on? What are the most common ones? I mean, you mentioned a lot of them, but what are the things we actually want to test for and how do we test for those?

Chris Kresser:
So this is one of the biggest challenges, unfortunately, and you know this Mark from your practice. What would be perfect is if there was a single panel you could run with a single body fluid that would accurately test all nutrients. That’s like the holy grail. I wish. If there’s one thing I’ve always wanted as a clinician that I’ve never had, it’s that, right? But you know that with each different nutrient, you have to test it differently. So for example, you can’t really assess vitamin K-2 in the blood accurately right now. There are some surrogate markers you can use to estimate levels, but you’re not getting an accurate measurement. With iodine, if you want to know long-term iodine status, you have to test it in the hair. If you do a urine test, you can see how much the patient has consumed in the past 24 hours, but that doesn’t really tell you long term status.
Nutrients like B-12, if you do serum B-12, you can get a decent idea, but serum B-12 doesn’t go down until stage three and four of B-12 deficiency, which is the final stage. So to get a more accurate assessment of early B-12 deficiency, you have to test methylmalonic acid or homocystine. So you get the idea. It’s very complicated and it’s rife with problems, which is one of the reasons why I think the estimates of nutrient deficiency are even as shocking as they are are low. Because let’s just take B-12, if a clinician runs a serum B-12 test and the B-12 is low normal, they’ll be told your B-12 is normal. But if I was to then run homocystine or methylmalonic acid on that patient, they’re way out of range. That already tells us that that patient’s not getting enough B-12 and they’re already experiencing significant effects of that. So I think the most-

Dr. Mark Hyman:
So Chris.

Chris Kresser:
Yeah, go ahead.

Dr. Mark Hyman:
So what are the top nutrition tests and what are the ones we should be telling everybody to get that are going to reveal the most relevant deficiencies?

Chris Kresser:
Yeah, I mean, I think just to keep it simple, and even with the stuff that’s available from every local doctor, vitamin D would be at the top of the list, right?

Dr. Mark Hyman:
Vitamin D3, right? Yeah. Because a lot of the doctors will not measure the right vitamin D.

Chris Kresser:
Yeah, yeah. Let’s measure that, 25D and pretty much, you should be able to get this with every doctor’s office insurance. I think serum magnesium, as imperfect as it is, because it’s only measuring the half a percent of magnesium that exists in the blood, not the … the rest of the magnesium is locked inside of the cells and tissue, so it doesn’t show up in the serum, but you can generally assess where it is. That’s really important because magnesium is a critical nutrient. Just don’t rely 100% on that. If you have other symptoms of not getting enough magnesium and your serum magnesium is normal, I would still follow up on that. I run B-12 and folate on every patient, in part because they’re so important for the health of the nervous system and the brain. And obviously we’re suffering from epidemics there with brain and nervous system conditions. And so many of the drugs, as you pointed out, Mark, interfere with B-12 and folate absorption. So it’s very typical for me to see low B-12 and low folate in the serum. I run homocystine-

Dr. Mark Hyman:
Yeah. So you run those other tests too, the homocystine methylmalonic acid.

Chris Kresser:
Exactly. Yeah. So I run-

Dr. Mark Hyman:
Which are better indicators.

Chris Kresser:
Serum homocystine, and that doesn’t just tell you about folate and B-12, it tells you about your inflammatory status. So I think that’s a really helpful marker. It’s a risk factor for cardiovascular disease. And then urine and serum methylmalonic acid as another way of checking B-12 status. I do zinc and copper on every patient. Excess copper is associated with dementia and Alzheimer’s and a bunch of other neurodegenerative conditions. And zinc is critical for our brain function and immune function, which is particularly relevant these days. So I always want to assess zinc levels and see where that is. Calcium is difficult to measure in blood because it’s so tightly regulated in the blood that if our intake drops, the body will just pull calcium out of the bone in order to maintain a normal blood calcium level. And that’s of course why low calcium intake in the diet leads to osteopenia and osteoporosis.
So for calcium, we use chronometer, which is just a way that patients record what they eat very carefully over a three day period. And then that gives us an idea of how much calcium they’re getting on a daily basis. It should be a thousand to 1200 milligrams a day, depending on age and whether they’re pregnant, et cetera. And if they’re not, then we need to look at other ways of getting calcium. So that’s a pretty simple approach with mostly tests that are available from any doctor. And then one way of assessing a nutrient that you could do on your own with a simple app.

Dr. Mark Hyman:
So Chris, that was a really helpful overview of some of the diagnostic testing. What I kind of like to know is what are the symptoms that people can identify in their own bodies for the most common nutritional deficiencies? Because when I was in medical school, we didn’t learn about how to identify nutritional deficiencies unless it was scurvy or rickets or Beriberi or Pellagra. There wasn’t like, what is the kind of low level insufficiency or deficiency symptoms for many common nutrients. So once I began to learn that, they were easy to spot and in functional medicine, we actually now have a curriculum for a nutrition focused physical exam. So you can identify not only symptoms, but physical signs of inadequate nutrition. So take us through what that looks like and what are the kinds of things people can identify for themselves for the common ones, and we can riff on that for a bit.

Chris Kresser:
Great. Yeah, I think it’s worth pointing out, one of the challenges here is that the body needs 40 micronutrients at least to function properly. And if we don’t get enough of any of them, everything kind of breaks down because nutrients are the fuel for every physiological process that happens in the body. And what’s difficult about this is that if you have a severe deficiency of vitamin C, for example, you’ll get scurvy. And that’s pretty obvious. You’re not going to miss that. But if you have a mild deficiency of vitamin C, you might find yourself getting a lot of colds and flus and other types of infections. You might find your inflammation and oxidative stress is going up and that might manifest as pain in your body and other symptoms that are not very easily, unless you’re a practitioner and you’re aware of this kind of thing, traced back to a moderate or mild vitamin C deficiency. So I just want to start there because it’s important to know that not getting enough of these things is not necessarily going to kill you, at least not right away.

Dr. Mark Hyman:
In the short term. In the short term.

Chris Kresser:
In the short term, it’s going to increase your risk of all kinds of chronic diseases that are the leading causes of death. In the US now, seven out of 10 of the leading causes of death are chronic diseases rather than acute problems. But if we start from just the very basic things to look out for, I’d say fatigue and low energy would be at the top of the list. There’s so many people who just don’t feel like they have enough energy to get through the day. And if I have a patient that feels like that, I’m going to be thinking about nutrients right off the bat. And that can vary all of the B vitamins. B-1 is really important for energy, B-12, folate is important for energy, Magnesium is important for energy, even vitamin D is important for energy. So people don’t tend to think about that very much. But-

Dr. Mark Hyman:
Like Fibromyalgia and vitamin D go together, right?

Chris Kresser:
Absolutely.

Dr. Mark Hyman:
Muscle soreness, some fatigue and depression.

Chris Kresser:
Yeah, I mean let’s just keep going down. So low mood, so maybe not full on clinical depression, but just mood swings or mood changes, certainly depression, anxiety, lack of focus, and then the whole range of cognitive symptoms like brain fog, difficulty with word recall, poor memory, inability to focus for long periods. If you go to your doctor and complain of this, they’ll just pat you on the back and say, welcome to old age. Or that’s just part of the normal aging process. I don’t think it is. Maybe to some extent, but what happens when we age is we’re less likely to absorb a lot of the nutrients that are critical for brain functioning and cognitive health. So I would say that whole range of symptoms is important.
Digestive symptoms, this is something that people often don’t realize is that the gut is a smooth muscle, it’s part of the nervous system. And just like every other system of the body, it needs certain nutrients to function properly. So we need all of the fat soluble vitamins are important, the B vitamins are important, zinc is important for the gut. And if you are not getting enough of those nutrients, your gut health is going to suffer as a result. And then I would say if you’re feeling depleted and you’re not really responding to stress very well, you’re not very resilient, you feel like you’re just continually catching the latest cold or flu or you don’t have a lot of buffer for the daily stresses of life, then you definitely have to look at your magnesium levels as probably one of the most important nutrients that governs our stress response. All of the B vitamins of course are really critical. Zinc and copper, really important for the nervous system. Again, the fat soluble vitamins.
And then another one is both male and female hormone imbalances. So women who are dealing with issues around menstrual cycle, sexual vitality. And then men also dealing with similar issues with sexual vitality and just strength recovery and performance. The production of all of the sex hormones, estrogen, progesterone, testosterone, and all of the ways that those hormones are converted in the body depend on several different nutrients. And when you’re low in those nutrients, then you’re not going to get optimal conversion of those hormones. So the entire endocrine system will be affected. So I know I just basically rattled off the whole body and most potential symptoms you could have, but that’s the reality we’re facing because like I said, nutrients drive all of those chemical biochemical processes in the body.

Dr. Mark Hyman:
I mean that’s a lot, but I sort of want to unpack that a little bit. So first of all, it’s important for people to understand that vitamins and minerals and nutrients are so critical to every function of the body because they’re helpers for all the enzymes. And enzymes are catalysts that convert one molecule to another molecule. And this is happening literally trillions of times a second in your body. So literally these trillions of reactions a second in your body that all depend on having adequate levels of nutrients to make these chemical reactions run. And one third of your entire DNA codes for enzymes, think about that. And that means that those enzymes are variable in the population and some people need more or less nutrients, but those are so critical to have the right amounts and the right forms of nutrients to make those enzymes work and make your biochemical machinery work. That’s why they’re so important.

Chris Kresser:
Absolutely, and if I could just interject on that, magnesium is a great example of that, right? When we first started this, or you’ve been doing this for longer than me, but when I first started, the stat I saw was magnesium was a cofactor for 300 different enzymatic reactions. About 10 years later, it was 450. And the most recent research I’ve seen is that it’s now over 600. So what that tells us is it’s already a lot, but we’re just barely even understanding the extent to which these nutrients really provide that support to all of the enzymatic reactions happening in the body.

Dr. Mark Hyman:
Yeah, exactly. Right. I mean, I was going to say that. That’s exactly what I was going to say. Drugs work on a single pathway or a single enzyme, these compounds, magnesium, Zinc, whatever, it works on literally hundreds of different enzymes. And things like vitamin D actually modulate gene expression and hormone regulation. And I mean there’s just so many different factors that they regulate in the body. So when you don’t have the optimal levels, it’s a problem. And like you said earlier, most of the nutritional guidelines are around addressing deficiency diseases, which we found 120 years ago, and we’re still basing our nutritional recommendations on that instead of what do our bodies need to optimally function, hence the word functional medicine.
And Robert Heaney was a vitamin D scientist who wrote a brilliant article years ago called Long Latency Deficiency Diseases. So he says, Well, if you don’t have enough vitamin D in the short run, you get scurvy. And if you don’t have optimal levels in the long run, you get osteoporosis or depression or muscle weakness. If you don’t have enough folate in the short run, it’s an acute deficiency, you’ll get anemia. But in the long run you might get cancer or heart disease or depression or dementia. So it’s a really different way of looking at these nutrients.
So what is the optimal levels? And that sort of begs the question of the testing we talked about earlier, which I think there’s a company that I’ve become the chief medical officer of called Function Health, which was designed to empower people with their own health data, their own health information, be able to do $15,000 worth of diagnostic testing for 500 bucks or less than 500 bucks and get your numbers, including a lot of these nutrient levels we’re talking about, and then learn what to do about them. And not just what the reference ranges are, but what are the optimal ranges. Like vitamin D you say, well if it’s less than 20, that’s a problem, or some labs say less than 30, but it should be over 45 or 50 to be in the optimal range. So we really have to rethink what we’re doing.

Chris Kresser:
Yeah. Mark, there’s another issue when it comes to nutrients that I think we should talk about that I don’t think it’s enough airtime, and that’s nutrient synergy. So nutrients don’t exist in isolation in the body as you well know. They play synergistic roles. And you could have adequate levels of one nutrient, let’s say iron, you’re getting enough of it in your diet, but if you’re not getting enough of the nutrients that support iron absorption or metabolism, then you could still be iron deficient. So for example, copper, we know that copper’s needed for iron to be utilized and absorbed. And if someone’s copper deficient, they could be iron deficient, even if they’re getting enough iron. We know magnesium is needed for the biosynthesis and transport of vitamin D. So even if you’re getting enough D, if you’re not getting enough magnesium, you’re going to have problems there. And I mean the list goes on and on, but the point is that nutrients operate in this synergistic relationship. So we have to make sure we’re getting enough of all nutrients, not just individual nutrients.

Dr. Mark Hyman:
Yeah, it’s true. I just think even one organ like thyroid, for the thyroid hormone to be made, you need iodine. For the T4, which is the inactive hormone to be converted to the active hormone, you need selenium. For the T3, which is the active form to bind to the nuclear receptor, [inaudible 00:35:01] it’s actually need vitamin D-3. So it’s like you need all these different things, they work as a team. And so what’s so crazy about modern nutrition and supplement research is they single out one nutrient that they think might be beneficial and they study it alone. And I’m like, well, if Michael Jordan was the best basketball player in the world, if he was on an NBA team by himself, he would lose every game.

Chris Kresser:
That’s right. But as you well know, that’s an artifact of drug research, right? And they want to isolate the single compound and then control all the other variables and keep them similar. But that’s not how functional medicine works. That’s not how the body works. It’s really a complex symphony of interactions all the time.

Dr. Mark Hyman:
And they work literally on hundreds of different pathways and enzymes and I mean each nutrient can have literally hundreds of different effects in the body and be in about a hundred of different processes. So it’s important to make sure we [inaudible 00:35:59]-

Chris Kresser:
And we’re still learning about that. Right?

Dr. Mark Hyman:
Yeah.

Chris Kresser:
It’s just crazy. I mean I think we’re just scratching the surface on understanding because it’s so complex that we have just applied our kind of reductionist allopathic framework to try and understand these nutrients. And there are some researchers out there like Gregory Scriness and others who are looking at food synergy as this complex web of interactions and maybe even with AI and some of the new tools that we’re going to have available to us we’ll be able to figure some of this stuff out. But just for listeners, anyone watching or listening, this is why Mark and I are such big fans of getting as many nutrient needs as you can meet through food because food has those. When you eat a food, it doesn’t just have one nutrient, it has multiple different nutrients and often food contains the actual nutrients that support the other nutrients in that same food, that’s nature’s intelligence, right?

Dr. Mark Hyman:
It’s so true. It’s so true. It’s so funny, people ask me, well, can I take all these supplements at once? I’m like, I say, does your body know what to do? I’m like listen, do you realize how many molecules are in the food you eat? How many phytochemicals? Hundreds and hundreds of vitamins, minerals, all these different kinds of compounds your body has to totally deal with. Your body is super smart and knows what to do with all of it.

Chris Kresser:
That’s right.

Dr. Mark Hyman:
Let’s talk about another concept here. I think there’s a lot of fear sometimes about taking too much or overdosing and there are certain nutrients which you have to be careful of. And there’s others that doctors might do a blood test on someone taking B-12 and go, Oh my god, your B-12 toxic. Stop it right away. I’m like, well no, you really can’t be B-12 toxic, only if you don’t take enough folic acid. And so there are certain things you have to be careful of. For example, the Inuit would know that if the foreigners, the explorers back in the day they didn’t like them because they were disrupting their culture, they would feed them polar bear liver, which had huge amounts of vitamin A in it and they would get vitamin A poisoning and they would die. So you have to be careful of some nutrients. So tell us about the ones we have to be careful of.

Chris Kresser:
That’s true. So you mentioned vitamin A, I think that vitamin A is a concern at extremely high doses, but it’s worth noting that having adequate levels of vitamin D and K-2 really increase the toxicity threshold of vitamin A. So put another way, if you’re deficient in D and K-2, you’re going to get toxic effects of vitamin A at a much lower dose, whereas if you’re getting enough K-2 and D, you would have to be supplementing with crazy amounts of vitamin A or you’d have to be eating polar bear liver or lots of beef liver every day for that to be a concern. Vitamin D, you can overdo it with D I almost hesitate to even mention it because 94% of Americans don’t get enough. So we’re not talking about a common problem here, I just want to emphasize that. Most people are not on that end of the spectrum, but you and I have both seen people in the clinic who come in and they’ve been taking 50,000 IU of vitamin A a day for years and their level is-

Dr. Mark Hyman:
Or Vitamin D.

Chris Kresser:
Or vitamin D, right. And their serum level is like 140. Well that is toxic and that can increase the risk of kidney stones and heart disease, et cetera. But at the doses that most people take, let’s say 5,000 IU per day, there’s almost no risk of toxicity in most people.

Dr. Mark Hyman:
It’s true. I mean, you’re right Chris. I think there’s a lot of misunderstanding about what the ideal vitamin D level is. And the way we look at nutrients, we talked about this before, is that it’s a bell curve, which is what’s normal for the population. But if 80% of the population is low in vitamin D, because we live and work inside, your normal level would be 20 or 30. But that’s not the actual ideal level, that might not be optimal. And the reality is that you can tolerate a lot higher doses, even the upper range of what they call normal, like a hundred on some tests or 75 is not really toxic at all. In fact, Dr. Robert Heaney, he was a vitamin D expert, did a study where they looked at 10,000 units a day for three months in healthy young males and there was no harm at all from that dose, which is a lot. It’s way more than I give most patients. So if you’re a lifeguard, your level might be 200. So I think people shouldn’t worry about too much vitamin D unless you’re doing stupid doses or you’re not taking a brand that’s reputable. Because sometimes the brands will say, 5,000, but they might have not tested the product.

Chris Kresser:
Yeah. I have some crazy patients who tend to overdo it. So I’ve seen a couple cases but I don’t think it’s a concern for most people. As we said, almost 95% are deficient. So that’s a far bigger problem. Calcium I definitely have concerns about, but not from dietary calcium but from people taking too much supplemental calcium. There are studies showing that can increase the risk of kidney stones and even heart disease because when you take it in really large doses as a supplement, it ends up in the blood and the body doesn’t really know what to do with that. It doesn’t get into the bones and the teeth where you want it, it gets into the soft tissues instead. So that’s a problem.

Dr. Mark Hyman:
I don’t know about you Chris, but I never recommend calcium supplements.

Chris Kresser:
I don’t.

Dr. Mark Hyman:
I used to, because that’s what I learned to do as a doctor, like 1500 milligrams a day. But it’s really not about how much calcium you’re taking in, it’s about how much is it being absorbed, about your vitamin D levels and about how it’s being used. And in countries, for example in Africa where they have very low calcium intakes like 300, 400 milligrams a day. They don’t have any osteoporosis because they have lots of other benefits that they have no side effects.

Chris Kresser:
And this is a great example of nutrient synergy. So vitamin D, vitamin K-2 and magnesium, all support calcium regulation and help calcium get into the bones and teeth where it’s needed and keep it out of the soft tissue. So there’s speculation like Chris Masterjohn, our colleague has written about this. He’s speculated that if you consider nutrient synergy and someone has optimal levels of D, K-2 and magnesium, the RDA, the recommended amount of calcium might be more like 500 milligrams a day instead of a thousand or 1200, which is what’s recommended right now.

Dr. Mark Hyman:
And that’s total including diet.

Chris Kresser:
That’s including diet, so not supplementing with that amount. Yeah. Iodine is one of those kind of Goldilocks ones because for most people they can get enough iodine from diet or supplementation. But for someone with Hashimoto’s, iodine supplementation particularly at higher doses might be problematic, especially if they don’t have enough selenium. So that’s another thing that. And then iron, again, iron deficiency way bigger problem, affects 2 billion people around the world. Iron deficiency anemia, even in the US it’s still a big problem. But it’s worth noting that hemochromatosis, which is a genetic condition that causes excess iron storage is the most common genetic condition in people of Northern European descent, it affects one and 200 people. So that’s not a small number of people in a country with 300 million people. And I do a full iron panel on everyone who comes into the clinic and I see iron overload all the time.

Dr. Mark Hyman:
Me too. I diagnose it so often it’s crazy. And I’m like, why did nobody ever pick this up on you before?

Chris Kresser:
That’s right. People could have it for decades and not even know it. So yeah, I’m not a big fan of iron supplementation typically, unless there’s a reason, unless we see that that patient has anemia or something like that. Even then I’ll often recommend liver or spleen, consuming organ meats if they’re willing to do that because that can really boost iron levels. But it’s a food based form of iron. So I think the body is able to regulate the absorption of it better than with iron supplements.

Dr. Mark Hyman:
So we’ve got vitamin A, vitamin D, iodine.

Chris Kresser:
Calcium.

Dr. Mark Hyman:
Calcium and then there’s a bunch more.

Chris Kresser:
Iron.

Dr. Mark Hyman:
Iron and then we also other fat soluble vitamins maybe can you get too muck K or B?

Chris Kresser:
Vitamin B, α-Tocopherol. Yeah, there’s studies suggesting that long term high dose supplementation with α-Tocopherol, which is the more common form of vitamin E has been associated with increased risk of prostate cancer in men and heart disease as well. Again, those are just the doses that we wouldn’t encounter in nature. More is not always better. We have to get out of that thought process in this country. What happened was they saw that vitamin E deficiency was correlated with a lot of problems, people not getting enough vitamin E in their diet and they figured, oh hey, if we just jack that way up, maybe we can prevent some of these problems. But of course the pendulum swung too far in the other direction. So I don’t recommend supplementation with α-Tocopherol at all.
Tocotrienols are a different story. They’re a new form of vitamin E that’s been recently discovered that doesn’t have that long term safety risk and they have some unique benefits and effects. And in fact, I included a tocotrienol product in my supplement line for that reason. But regular Tocopherols that you find in most multivitamins and supplements, I’m not a big fan of supplementing with them either.

Dr. Mark Hyman:
Yeah, I want to get into the forms of nutrients in a second because I think it’s a really important topic that most people don’t understand, which is it’s not just taking any old vitamin. It’s, what is the form of the vitamin? How bio available is it? How is it actually absorbed? Is it in a form that actually can be broken down and used by the body? And there’s so many other variables we can get into. Just to kind of close that loop on what we should be careful of. I think selenium, some minerals are a bit tricky-

Chris Kresser:
I was just about to say selenium.

Dr. Mark Hyman:
Like Selenium, you got to be careful with, don’t want to eat too many Brazil nuts.

Chris Kresser:
Yeah. Or even some supplements have like 300 micrograms of selenium and that’s going to be too much for most people. It’s definitely a Goldilocks range for that one for sure. It’s one of the more toxic minerals.

Dr. Mark Hyman:
But some magnesium for example, unless you have kidney failure, it’s just going to give you diarrhea. It’s not toxic. So it’s kind of confusing. Some vitamins are bad, some minerals are bad to overdose, others are not. Like you can take all the B vitamins you want, you’re just going to pee them out. Your body’s not going to … [inaudible 00:46:27] from toxins.

Chris Kresser:
We should mention potassium. You don’t want overdo it on potassium because it plays an important role in muscle contraction, including the heart contraction and action potential and cellular communication. And so getting plenty … our ancestors got up to 10,000 milligrams of potassium in their diet and that’s no problem. But if you’re supplementing, you should not be taking gram level quantities of potassium I think because that can be problematic.

Dr. Mark Hyman:
All right, well let’s talk about the forms of nutrients now, Chris, because people go, well I can go to Costco or I can go to CVS or Walgreens and just pick up the cheapest vitamin. It’s a vitamin. What’s the difference? I got everything in there. It’s fine. What is the problem with doing that? And why should we be more diligent about the quality of the supplements we’re taking and why does it matter? Both in terms of the actual form of the nutrient, but also what else is in that vitamin in terms of fillers, gums and flavorings and colorings and all this stuff. It’s kind of crazy. I mean you go to buy Centrum and it’s like blue. I mean why do you want to take the blue dye for 30 years? I’m like, I don’t want to take blue … anything with blue dye, I mean if it’s a blueberry I’ll take it. But it’s like the blue pill and the red bill. I’m like, you don’t need a blue pill or red pill. Vitamins shouldn’t have colors except their natural color.

Chris Kresser:
Yeah. Exactly. So yeah, I mean I think the forms of the nutrients, oftentimes products will use synthetic forms because they’re a lot cheaper to put in there. And the problem with that is in many cases those forms are foreign to the body. The body has not encountered those forms of those nutrients historically and doesn’t know how to digest and absorb and process them effectively. So some good examples here would be folic acid is a synthetic form of folate and some people are able to convert that into methyl tetra hydro folate, which is the more active form of folate that we want. But in quite a number of people that conversion doesn’t work well and they can end up with unmetabolized folic acid in their blood-

Dr. Mark Hyman:
I’m one of those.

Chris Kresser:
And that’s been linked to cancer and other health problems.

Dr. Mark Hyman:
Yeah, yeah. I’ll tell you a story about that, Chris. I just interrupt you for a sec.

Chris Kresser:
Yeah. Please.

Dr. Mark Hyman:
I was in this movie Fed Up, which was released in 2014 about the food system and obesity in kids. And the director of the film was not a patient, but she talked to me about this problem that she had where she would have recurrent miscarriages and she couldn’t get to have a baby and she ended up having a pregnancy but had almost a full term anencephalic baby, which means no brain, basically. And it was just horrible. And so she read this article that I wrote years ago on methylation, and for those of you who know what that is, it’s basically the chemical reaction that happens all the time in the body that’s facilitated by certain enzymes that require B-12, Folate, B6 and a bunch of other stuff.
And so she read the article and there’s a gene, like you mentioned, that people can’t convert from the bowl that you eat in your diet to the methyl folate that you need to run everything. And she said to her doctor, Hey, I think I might have this. And she asked for the gene test and sure enough she had the gene that was the funky gene that prevented her from metabolizing this properly. And then doctor said, Okay, I’m just going to give you some folic acid. And she’s like, No, no, no. Dr. Hyman says I need to take methylfolate. So she did. And it was quite amazing because during the movie premier and in the PR on the movie, I was traveling on New York City with her and she had this 10 month old beautiful baby boy with her that she was taking care of on our little film tour. And it was just such a beautiful story of how powerful these nutrients are and why it’s so important to get the right one and the right one for you.

Chris Kresser:
Absolutely. So yeah, that’s a great example. And so many women have benefited from that same kind of approach. And where they’ve taken folic acid, it hasn’t worked or even caused harm, they’ve switched over to 5-MTHF, which is the more active form, or even folinic acid, which is a more active form and they do well. So that’s one example. Cyanocobalamin is another example. That’s a form of B-12 that’s often in cheaper B-12 products. And again, some people do just fine, they’re able to convert that into methylcobalamin or adenosylcobalamin, which are the more active forms, but other people cannot. And they can take cyanocobalamin all day long and they don’t experience any of the benefits that they would get if they were taking one of the more active forms like methylcobalamin.

Dr. Mark Hyman:
Yeah. Exactly.

Chris Kresser:
And then vitamin A, betacarotene is a less active form of the active form retinol and carotenes have some important functions in and of themselves in the body. So I’m not saying carotenes are bad. And a lot of people can convert carotenes into retinol, but there are some people who can’t do that very well. And there are even some who can’t do it at all. So if you ever have seen someone who does a carrot juice fast and then their palms turn orange-

Dr. Mark Hyman:
That was me.

Chris Kresser:
That is one of those people.

Dr. Mark Hyman:
I did that years ago. I was drinking tons of carrot juice before I kind of got the message that sugar wasn’t so great. And I was like, Oh, this is healthy. It’s carrot juice. I literally, I’m like, wow, I look like the orange man.

Chris Kresser:
It’s like jaundice or something.

Dr. Mark Hyman:
Yeah.

Chris Kresser:
Yeah. I’ve been in a tanning bed. So that can happen. Less vitamin K-1, which again is important, it has some important roles on its own, that can be converted into K-2, but not always. So it’s helpful to take vitamin K-2. Preform alpha-Linolenic acid, which is a precursor to EPA and DHA, the long chain omega-3 fats. Only about half a percent of that gets converted into EPA and DHA. So people who are supplementing only with flax oil, they could end up being deficient in DHA even if they’re consuming a ton of that stuff. So those are some of the main examples.

Dr. Mark Hyman:
A lot of people who are vegan will supplement with, for example, the omega-3s from plants like walnuts or flax seeds and they don’t convert. And I test everybody’s essential fatty acid levels and it’s just shocking you see high alpha linolenic acid, linolenic acid and then really low EPA DHA, which are the active important forms that you need for your brain function, inflammation and regulating all these different functions in your body and they just can’t make it. So it’s really important. And then besides that, Chris, there’s also the problem, not just the form of the nutrient from its bioactive form, but even from its absorption. For example, magnesium we talked about with 700 enzymes. Magnesium citrate and glycinate and three and eight and all these other forms are well absorbed, but oxide is not. But it’s also the cheapest form of magnesium. So that’s what’s in most of the supplements you get in the grocery store or Walgreens or cheap supplements and it’s like, sure you got magnesium in the label but it’s not working.

Chris Kresser:
Yeah. And there are things you could do, you can chelate it and make it a buffered form or you can turn it into a bisglycinate and make it well absorb. But just the standard magnesium oxide is just going to go right through you, literally. And that’s what happens when people take too much magnesium oxide and they use it as a laxative and it might work for as a laxative, but it’s not working as a magnesium supplement because it’s literally going through you. And then as you mentioned Mark, there’s a lot of products that just contain a lot of stuff that you don’t want to be putting into your body on a regular basis. All the dyes and the artificial compounds and things like that. So-

Dr. Mark Hyman:
Like lactose and gluten and all kinds of stuff.

Chris Kresser:
People sometimes say, Oh, it’s cheaper, it’s 20% cheaper or whatever. But I’m like, okay, if you’re not getting any benefit, then the difference between $22 and $24 if you’re getting a benefit from the $25 or $24 product, but no benefit from 22, what’s the more expensive product really? It’s the one that you’re paying almost as much for but getting no benefit from at all. Or even being harmed by.

Dr. Mark Hyman:
It’s sort of like that, you get a car with 10 miles per gallon or car with a hundred miles per gallon. It doesn’t matter. So let’s talk about something else because I think-

Chris Kresser:
Especially over time.

Dr. Mark Hyman:
I want to talk about this sort of next topic I’m really interested in hearing from you about is phytochemicals and phytonutrients. It’s one of my favorite topics I talk about. And the more I learn about it, the more excited I get. It’s really where the food is medicine conversation comes in. And you can get these from food, but you can also get these from various supplements and different forms. Why are they so important? And I also want you to touch on the idea that is important because there’s a lot of people who are embracing a eating philosophy that I have some concerns about that could be very therapeutic in the short term, but it’s people who only eat meat, the carnivore diet, meaning they don’t eat any vegetables. And I mean, it’s sort of the opposite of vegan. It’s like only animal products.

Chris Kresser:
So I wrote an article a while back called What’s the Optimal Human Diet? And I did a really deep dive on this topic and I looked at it through different lenses. So if we study ancestral diets and human populations from all over the globe from different time periods, what can we determine from that in terms of the best mix of foods? What can we determine from clinical research, actual randomized controlled trials? And then what can we determine from observational nutrition research, which is highly problematic as we both know. But you can still glean some important patterns from that. And no matter which of those three lenses you look for, I came to the conclusion that the optimal human diet contains a combination of plant foods and animal foods in some combination. Now what that specific ratio of plant versus animal foods is can vary from person to person, culture to culture, there are examples of cultures that are extremely high intake of animal foods with a fairly low intake of plant foods that were really healthy like the Inuit for example.
Then you have examples on the other end of the spectrum of the Tukasenta in Papua New Guinea who consume almost entirely plant foods but then went out of their way to obtain just even a small amount of highly potent animal foods because they understood that that balance was important. And then you have everything in between where people consume sort of more roughly even percentage of calories from animal and plant foods. And the reason that that’s important is that we get different nutrients from different foods. So the essential vitamins and minerals are often higher in animal foods. So organ meats, for example, are really high in zinc and iron and choline and B-12 and folate, and all of those essential vitamins and minerals. But the plant foods tend to be higher in, not surprisingly, the phyto, which means plant and the plant forms of nutrients like carotenoids and flavonoids and lignins and beta-glucans and all of these nutrients that 50 years ago we knew very little about their impact on human health. But when you look in the scientific literature in the past 10 to 20 years, you just see that even though these are not currently thought of as essential, meaning we can’t live without them, you can technically live without them, but you’re not going to live a very good life if you’re not getting a lot of them. And you’re not going to live a very long life, most likely.

Dr. Mark Hyman:
That’s right. I mean, I just came back from in Korea and Greece and it was amazing what they ate there. And they ate so many wild foods, Chris, and they had one staple in their diet, which was wild sage tea and all these wild herbs growing everywhere. And I was like, what is this wild sage stuff? So I kind of looked it up, I found the plant name for it and got all geeky about it. And it literally is very, very rich in and catechins, which are the compounds in green tea that are so beneficial for longevity, for healthy aging, for detoxification as an antioxidant. They help detox heavy metals, blood sugar. So it’s quite fascinating to see how these staple plants in these cultures are so important, especially those who live to be a hundred. Because I think Korea’s one of the blue zones where people live to be well over a hundred and they have wild greens.
I mean you go to any restaurant, they have wild greens on the menu. I’m like, How do they do this? And they just go out and pick greens everywhere. And I’m like, there’s summer greens, there’s winter greens. So I think the phytochemicals are so key. But what really is exciting to me, and this is an interesting conversation we haven’t really had, but I met this guy named Fred Provenza. I’ve had him on the podcast twice and he’s written a lot about this. And Stephan van Vliet also who’s now at the Utah state and was at Duke, has done a lot of work looking at grass fed animals, eating a wide variety of plants that have high levels of phytochemicals in their meat and milk, which is mind blowing. And they found, for example, if certain goats are eating certain shrubs, whatever I just mentioned about the wild sage, that they have as high levels of catechins, for example, as green tea. So in a way we’re seeing phytochemicals in animal foods which we never thought before existed. And then there seems to be more interesting is that they get metabolized to different forms that may be even more effective. Right?

Chris Kresser:
That’s right. Yeah. And the animals are doing the work for us and in many cases the animals do that work more efficiently because that’s the food that they’re designed to eat, grasses and other plants that we couldn’t even digest if we were to eat those. And we certainly wouldn’t extract all of the nutrients from them. And you can even see this just on a very basic level, if you’re eating pasture raised eggs and you have your own chickens, let’s say in your own backyard or you’re getting them from the farmer’s market, you’ll see the color of the yolk change throughout the year as those chickens are eating different compounds. You can even see that in milk and taste the flavor of the milk change if you’re getting milk from pasture raised cows. So yeah, that’s a really important thing to understand. It’s not just what we eat, of course, it’s what anything that we eat that also is eating for the pasture raised animals.
But just going back to the carnivore thing, I think you and I are on the same page here. I’ve had Paul Saladino on my podcast who’s a big proponent of the carnivore diet. Sean Baker I’ve talked to. I try not to be dogmatic about these things, just keep an open mind. And I’ve had patients who’ve been suffering from severe autoimmune disease who’ve done a carnivore diet and have had a miraculous response. So I just want at least acknowledge that that happens. And I don’t judge anybody who’s in that situation for pursuing that approach because it can be life changing and I totally understand why someone would do that. At the same time, that doesn’t mean that it’s the best strategy to follow long term. There are lots of things that we do to improve our health in the short term that are not sustainable long term.
Like fasting. They call it the cure for all disease, but it’s pretty obvious that you can’t fast for the rest of your life or your life will be very, very short. So I kind of tend to think of carnivore diet almost as that kind of approach. Like a very intensive gut rest where most of the foods being absorbed pretty high up in the small intestine and it gives the colon and the large intestine the rest. And maybe some stuff happens there that’s pretty similar to what you would experience fasting, but it allows you to do it for longer because you’re still getting some of those essential nutrients. But I just have concerns about somebody following that approach indefinitely for the rest of their lives because there’s not a single example that I’m aware of, of an ancestral population that only ate animal foods with no phytonutrients at all. And then just the research that’s coming down the pipe on phytonutrients and their benefit and importance to health makes me cautious about that for sure.

Dr. Mark Hyman:
Oh totally. And I think it’s also not just what you’re eating, it’s what you’re not eating. So if you’re not eating plants, you’re not having gluten, you’re having all these other things that could be potentially irritating to your gut. And so yes, sometimes I do take people off a lot of plant foods when I’m trying to heal autoimmune disease. I take them off grains and beans. I do the 10 day detox diet, which essentially is an elimination diet, and that really works really well. So I think it’s really about personalizing the approach, figuring what you need. But the fact that you and I sort of agree after looking at all the research is not a surprise. I mean the data is the data and if you take a dispassionate look at them, that’s not ideologically based, then you can actually come up with pretty similar conclusions.
I always say, don’t let your ideology run over your biology. I have a friend who’s a vegan and we just did his blood test and it’s like, I mean he is a 50 year old guy, but he exercises, he eats healthy foods, doesn’t eat junk, but he has severe anemia, he’s iron deficient, he’s got severe B vitamin deficiencies. He’s got-

Chris Kresser:
Probably EPA and DHA, unless he’s supplementing with that.

Dr. Mark Hyman:
Oh my god. Yes, he said he was supplementing with this product, and this is an example, he sent me the package, he’s like, this is a plant based form of EPA and DHA with a thousand milligrams of EPA and DHA. And I’m like, I was kind of suspicious because I’ve been doing this a long time and I don’t really know how that works. You can get algae and get DHA, but you can’t get EPA. And I just was confused, but I’m like, all right, well let’s just check because I’m like, if you found something, let’s hope it works. And he was like, zero, zero EPA DHA and I’m like, God, it’s marketing. It’s just not true. So he has all these significant nutritional deficiencies. And I was kind of shocked to see someone who was so conscious about their diet, he wasn’t a junk food vegan.

Chris Kresser:
Totally. No. For a while in my clinic, we had a way that we would onboard new patients where they would do a blood test before they even came to see me in person so that I had the test results. And so I would see the results before I saw the patient or heard anything about their complaints or what they were up to or their history. And over time I began to be able to recognize, oh, this is a vegan, this is a vegan’s blood work, this is a vegan’s blood work. Because I would see the same constellation of patterns, low B-12, low anemia, iron deficiency anemia, low EPA and low DHA, low zinc, et cetera. And of course that’s not true for all vegans, but there was definitely a higher risk of those kinds of deficiencies happening in those situations.

Dr. Mark Hyman:
Right. Amazing. So let’s talk about what the most nutrient dense foods are, because I think people are going to be surprised by this answer. What are the most nutrient dense food on the planet?

Chris Kresser:
Yeah. Organ meats. Liver number one. So this was Ty Beal who’s actually … Stephan van Vliet and Ty Beal, and some of these researchers who’ve been studying the nutritional value of pasture raised animal products and animal products in general. And this study was published in Frontiers it was spring of this year. It was Ty Beal and Flaminia Ortenzi and they work for an organ … I think it’s an NGO, but it’s an organization that’s trying to address hunger and starvation around the world and malnutrition around the world. And so their goal was to figure out, where can we get the biggest bang for our buck? If we’re going to find foods that we want to give to the people who are suffering from malnutrition around the world, what should we give them? Should we be giving them beans? Should we be giving them healthy whole grains? I’m doing air quotes here for someone that’s not watching. Should we be giving them lots of kale? What is going to make the biggest difference in their nutrient levels?
And so they created a scale to assess the nutrient density of these foods. This study was unique compared to all previous research that’s been done on this topic in that it was the first one to actually quantify and consider the bioavailability of a nutrient. Very important. Because for example, if you look on paper, you can see that spinach contains a lot of calcium. So you think, Oh, if I just eat a cup of spinach, I’ll meet my calcium needs for the day. That’s not the case because spinach also contains oxalic acid, which inhibits the absorption of calcium. So you only absorb 5% of the calcium in spinach, whereas from dairy products or bone in salmon or even cruciferous vegetables, it’d be closer to 30%. Right? So they actually considered bioavailability, which was a landmark effort. I’m so happy to see a paper that finally did. Now the top 10 foods, five of those top 10 foods were organs. So you have liver, kidney, heart, spleen, and pancreas. And we have dark leafy greens.

Dr. Mark Hyman:
Wait, what about thymus? I like the thymus. I like the thymus.

Chris Kresser:
Thymus wasn’t on there.

Dr. Mark Hyman:
Those are sweet breads. I love that.

Chris Kresser:
I don’t actually even know. Yeah. All of the organs are super nutrient dense.

Dr. Mark Hyman:
I went on a date once and I said, Hey, wanting some sweet breads? And she’s like, sure. And she didn’t really know what it was. She thought it was bread. I’m like …

Chris Kresser:
She had like a muffin or something. So those five foods, and then you have shellfish, small dried fish, dark leafy greens, so like kale, collard greens, et cetera. And then vitamin A rich vegetables like the brightly color, red peppers, yellow peppers, et cetera. That’s the top 10 nutrient dense foods.

Dr. Mark Hyman:
But it’s interesting, if anybody wants to just google nutrient profile of liver compared to let’s say, nutrient profile of the most amazing vegetable you could ever think of, broccoli or whatever, kale, whatever you think it is. And it’s like an Olympic athlete versus kind of a high school player. It’s like that is difference.

Chris Kresser:
Weekend warrior.

Dr. Mark Hyman:
It’s such a massive amount of scale difference. It’s like the graph is here versus here, you can’t really see my hands, it’s on the podcast, it’s really different and it’s such a-

Chris Kresser:
Yeah, we quantify that. So in this scale, lower was better. So a score of one would’ve been the highest score you could get for nutrient density. Liver had a score of 11, even other organs were in the forties, fifties, sixties. Then when you started to get into dark leafy greens, which are amazing, super nutrient dense, they were more in the hundreds. And then you had, whole grains where in the thousands. And then they had processed and refined flour. It was just not even on the chart. It was like they couldn’t even quantify … it couldn’t be in the same scale because they were so devoid of nutrients. And now that’s 60% of the calories that the average American consumes is from ultra processed food. So we wonder why we’re suffering from an epidemic of nutrient deficiency.

Dr. Mark Hyman:
No, no. There’s two points I want to also come up with about the liver thing. First, it’s like people who are listening go, Ooh. But I mean I’m Jewish. I grew up on chopped liver and we were really poor. I lived in a one bedroom apartment with my mother and every night we had chicken livers and onions. I thought it was a gourmet meal, but it was cheapest thing she could get.

Chris Kresser:
Lucky you.

Dr. Mark Hyman:
Cheapest thing she could get. But one of the things is like, how do you take it to make it taste good? And two, what about the toxins in liver? Because people are thinking about this thing. Oh well liver is basically your detox organ. So are you just getting all these nutrients, but you’re also getting all these toxins. Can you talk about that?

Chris Kresser:
Yeah. So that’s a common misconception, but we’ll start there and then we’ll go back to how to prepare it. So the liver is the organ that processes toxins, but it’s not the organ that stores them. And that’s the key difference. So actually the storage of toxins in our body happens in our fat tissues. So this is why if you eat animal products and you’re eating dairy products, which is pretty high fat, it’s very important to get Pasteur raised organic products because any toxins that those animals are exposed to are going to be stored in the fat tissues, not in the liver. So, that’s pretty easy to … It is a common misconception and it’s not really a concern.
In terms of making it more palatable. There are a lot of ways to do that. Probably the simplest and most straightforward is … and this is what I often tell to my patients is, take two, three ounces of liver, chop it up, add it to ground … if you’re having, let’s say ground beef, pasture raised ground beef and you put some Mexican seasonings in there to make tacos or something like that, most people are not going to even be able to detect that there’s liver in there and you don’t need a lot because it’s so nutrient dense. You only really need one or two servings of three ounces of liver a week to get the full value. So that’s one way to do it.
Some people cook it in milk, I’m not sure what culture that came from. Milk has some other issues, maybe not a good idea for some people, but if you tolerate dairy, you could consider that. Adding it to meatloaf’s, a grain free kind of meatloaf is another way to do it. But you should probably be telling us Mark, because it sounds like you grew up eating it all the time.

Dr. Mark Hyman:
Well listen, I love chopped liver, but that’s not for everybody, especially on a bagel. But anyway, the chicken liver and onions, you get organic organic chicken livers and you stir fry onions and you put the chicken livers in and stir fry them and you serve it. It’s so good. And pâté is another great way to get liver and you can put on flax crackers. I actually really like it. And I went to another blue zone, Sardinia and they served the whole nose to tail thing. This guy had this pig and he was like, listen, we flavor the meat before we kill the animal. Meaning we feed all these phytochemical rich plant foods, acorns, carob and wild this and wild that and that was so amazing. And he was so excited about preparing this pig meal and I don’t really eat that much pork, but I was like, okay, well this guy made it for me. And he served all the different parts.
And then one of the things, he had this whole dish of organs, it was spleen and liver and lung. And I was like, Oh, I don’t even eat lung before, but I guess I’ll try it. And it was actually pretty good. All right. I actually, I met this guy Chris, quite an amazing guy, I was at my favorite sauna place is a Russian bathhouse, Russian Turkish bath in New York City.

Chris Kresser:
You took me there. We went there together remember?

Dr. Mark Hyman:
I did, I did.

Chris Kresser:
I visited you.

Dr. Mark Hyman:
I did. It was so good.

Chris Kresser:
That was great.

Dr. Mark Hyman:
And this guy’s like, Hey, are you Dr. Hyman? I’m like, Yeah, yeah. He says, Oh wow, I love your stuff but I want to tell you what I’m doing. I’m like, what? And he is like, I have this company called Mighty Meats. I’m like, Okay, well what is that? He says, Well, we make organ meat hamburger. And I’m like, Wow, that’s amazing. So he’s going to send me something, I don’t have any affiliation with the company. But I was like-

Chris Kresser:
I have. Yeah, that’s great. And there’s so much like-

Dr. Mark Hyman:
Have you heard of this Mighty Meat? Have you heard of this company?

Chris Kresser:
I have. Yeah. They sent me some samples, it’s great.

Dr. Mark Hyman:
Yeah. And it’s this really cool guy.

Chris Kresser:
Yeah. They’re more and more like Epic, if you go to Whole Foods and they have meat bars and some of the meat bars have liver in them mixed with bison or beef or whatever. And so that’s another good way to get some liver in your diet if you’re having trouble cooking it or preparing it on your own.

Dr. Mark Hyman:
Now what about the supplements that they have with organ meat pills? It sounds kind of weird, but I’m like, does that work?

Chris Kresser:
Yeah, that works for sure. I have an organ meat supplement because I found in my many years of working with patients, I could only get a very small percentage of people that actually eat the organs. Liver’s one thing, but then spleen and kidney and pancreas, that was a whole nother ball game.

Dr. Mark Hyman:
I just liked kidney be pie. That was good. Beef and kidney pie, remember that?

Chris Kresser:
Absolutely. But yeah. And then heart, I call it the gateway organ meat because it’s a little easier for people to eat, but it’s technically a muscle, It’s not actually an organ and it doesn’t have the same nutrition. It’s loaded with CoQ10, which is great, but it doesn’t have the same nutrient profile that liver and kidney and spleen have. So yeah, the organs you want … obviously you want the supplements to come from a hundred percent grass fed animals. We use a source from New Zealand where I think the cattle are just exposed to far fewer toxins. No GMOs, no antibiotics, no growth hormones, none of that stuff. And then it’s just basically the organ meats, they’re raw and then they’re frozen and then they are dried and then that powder is what’s in the capsules. So it’s about as close as you can get to eating organ meats without actually eating them.

Dr. Mark Hyman:
So that’s amazing. It’s interesting, this is not a surprising thing when you look at animals like lions, they eat all the organs and then they leave the meat for all the scavengers. And then you see Native Americans also do the same thing. If anybody saw Dances with Wolves or The Last Mohicans, they go like to eat the organ, eat the liver, you grab it and that’s what you eat first. So it’s like a delicacy. So I think the-

Chris Kresser:
The highest status people got the organs. Right?

Dr. Mark Hyman:
Exactly. Exactly. Well, all right. So let’s talk about what you’ve done, Chris. Because you and I have been in this business a long time and it is frustrating to try to find the right supplements, to find the best products, to know what’s good. People are confused. And even myself who have been in this business a long time, I really have to do a lot of due diligence before I recommend to my patients this company or that company. And then even then I go, I don’t know, are they doing what they say they’re doing? And it sounds good in the marketing, but you decided to create a supplement company called Adapt Naturals and it’s quite different than other companies. So how is it different than other supplements? And tell us a little bit about it.

Chris Kresser:
Yeah, thanks Mark. So I’ve been doing this for 15 years, not nearly as long as you, but it feels like quite a while. And I waited that long to create a supplement line because I feel like it took me that long to learn what I needed to learn to make something that actually added value and was different than what was already available. So one of my big motivations was I think most people are really confused about supplements. I’ve seen this over and over. I ask everyone I’ve treated in that 15 year period to bring everything they’re taking into the clinic for their first appointment. And you know Mark, they wheel in a suitcase full of stuff or shopping bags full of products. And we start going through them and I’m just horrified often by what’s in the bag. And people started, their aunt told them about something nine years ago and then their a doctor and then they watched a summit and they started four other products. And I don’t blame them. It’s just super confusing to be a consumer in today’s marketplace.
And half the time they’re just throwing their money away. But some of the time they’re actually taking stuff that is causing harm. It’s not only not helping, it’s actually causing harm or they’re just taking way too much. They’re doing way more than they need to be doing. So I set out to just give people a simple but super effective plan that they can follow on a daily basis where they can get all of the nutrients they need, both essential vitamins and minerals like we’ve been talking about, and also the phytonutrients, the bioflavonoids, the carotenoids, the betaglucans, et cetera. And just kind of set it and forget it. Right?
So we created what we call the core plus bundle. It’s a daily stack of five products. It’s an organ supplement, not surprising. A mushroom product. Eight of the most evidence based edible mushrooms like reishi, Chaga, lion’s mane, Turkey tale, cordyceps, et cetera. Tocotrienols and magnesium. And when you put these together, they work in a synergistic way that really just supports all aspects of health. And we’re using, again, won’t surprise you, all of the most bioavailable forms of nutrients. Methylcobalamin, instead of cyanocobalamin. P-5-P instead of Paroxetine R-5-P instead of riboflavin. Folate instead of folic acid. Or using a hundred percent grass fed organs in the organ product. For the mushrooms, we’re using the full extract. So you have all of the terpenoids, the terpenes, the beta glucans, all of the compounds instead of just the simple, isolated nutrients that you get from the mushrooms. We’re using Delta and gamma tocotrienols. So this is the product of my 15 years of research and clinical experience. And I really put everything I had into creating this because I wanted to give people products that they could really trust.

Dr. Mark Hyman:
That’s so great. I actually can’t wait to try them. I want to get them. Are they available?

Chris Kresser:
You’ll get them.

Dr. Mark Hyman:
How do people get them?

Chris Kresser:
Available now. Yeah, they’re available now. So adaptnaturals.com, the core plus bundle is what we recommend. And Mark, we’ve been talking this whole time about how important a healthy diet and lifestyle is. You and I always have said this, you cannot supplement yourself out of a bad diet and lifestyle. And I put my money where my mouth is. We built an app called Core Reset, which has recipes, meal plans, shopping lists, guided stress management, audio and videos with me and other guests, movement programs. I wanted to give people everything they need to just follow a program for a month and get as healthy as possible. And that should always be the foundation. Don’t take my supplements and just expect that you’re going to be able to keep eating pizza and cheese doodles and stuff. You have to make those other changes too.

Dr. Mark Hyman:
Well, yeah. I mean that’s why they’re called supplements, not replacements.

Chris Kresser:
So we built this app and we’re giving it away for free to anyone who buys the bundle. That’s how serious I am about this diet and lifestyle being absolutely critical to this process. And we didn’t want that to stand in the way. We wanted to make it super easy for people to make those changes. And you get the app for life, you can keep it, it’s free if you order the bundle. There’s lots of great content in there.

Dr. Mark Hyman:
That’s good. So you got the multi in the bundle, you got the organ meats, you got the mushrooms, you got the magnesium, the vitamin E. It’s like awesome. I want mine. When am I getting mine, Chris?

Chris Kresser:
I’m super excited-

Dr. Mark Hyman:
Come on, we’ve been friends forever. When am I getting…

Chris Kresser:
It’s on the way. It’s on the way. I’ve been taking it myself, of course. I’ve taking it myself [inaudible 01:22:25]

Dr. Mark Hyman:
What do you mean? I just got back from a trip. Where’s my supplements?

Chris Kresser:
Well I couldn’t send it because the vitamin E, the gel caps are heat sensitive, I didn’t want them sitting outside your door. [inaudible 01:22:38]

Dr. Mark Hyman:
Okay. Okay. Okay. Okay. All right. Well Chris, I’m really proud of you man. I want everybody to know, I’ve been in this space for 30 years and there’s a lot of people who are in functional medicine and they’re all doing a great job. But there’s a few that really stand up and stand out and who’ve done the really hard work and my go to for a lot of stuff is Chris, when I want to kind of dig in on a topic, I’m like, what does Chris think? What did he do? And he’s just so religious about having an honest accounting of the research and not based on ideology or belief, but based on what does the science say. And so Chris is one of my heroes in functional medicine and I just want to say that upfront because I don’t say that lightly.
He’s a friend obviously. But I think that the work he’s done is so important to advance the field and he’s brought so many issues to clarity that people are confused about. And I’ve used his work in a lot of my books in sort of referencing and digging into stuff. Because he’s already done the homework, so I just kind of have to cheat and go see what he did and dig a little deeper and find it out. So I’m really proud of you, Chris, for creating this Adapt Naturals company, for doing the hard work of creating the supplements. I encourage everybody to check it out. Go to adaptnaturals.com and I’m just really, really happy that you did this Chris.

Chris Kresser:
Oh Mark, that means a lot coming from you. Definitely my mentor and hero in the functional medicine space. We wouldn’t be able to do it without all of the contributions you’ve made. So I’m honored to help in some small way and thanks for having me on the podcast.

Dr. Mark Hyman:
Of course, Chris. And everybody listening, hope you enjoyed the podcast. If you think somebody would benefit from listening, share it please with them. Friends and family on social media. Leave a comment, tell us how your life’s been changed by upgrading your diet and lifestyle, but also how have supplements affected you, because they can be really impactful? And subscribe wherever you get your podcasts and we’ll see you next time on The Doctor’s Farmacy.

Outro:
Hi everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.